It's important to keep your cholesterol levels within healthy limits. If you have other risk factors for developing heart disease, you need to be even more careful — especially with your low-density lipoprotein (LDL), or "bad," cholesterol level.

Interpreting your cholesterol numbers

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in the United States and some other countries. Canada and most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your cholesterol test (lipid panel or lipid profile) results to see if your cholesterol falls in an ideal range.

Total cholesterol (U.S. and some other countries)

Total cholesterol* (Canada and most of Europe)

Below 200 mg/dL

Below 5.2 mmol/L

Desirable

200-239 mg/dL

5.2-6.2 mmol/L

Borderline high

240 mg/dL and above

Above 6.2 mmol/L

High

LDL cholesterol (U.S. and some other countries)

LDL cholesterol* (Canada and most of Europe)

Below 70 mg/dL

Below 1.8 mmol/L

Ideal for people at very high risk of heart disease

Below 100 mg/dL

Below 2.6 mmol/L

Ideal for people at risk of heart disease

100-129 mg/dL

2.6-3.3 mmol/L

Near ideal

130-159 mg/dL

3.4-4.1 mmol/L

Borderline high

160-189 mg/dL

4.1-4.9 mmol/L

High

190 mg/dL and above

Above 4.9 mmol/L

Very high

HDL cholesterol (U.S. and some other countries)

HDL cholesterol* (Canada and most of Europe)

Below 40 mg/dL (men) Below 50 mg/dL (women)

Below 1 mmol/L (men) Below 1.3 mmol/L (women)

Poor

40-49 mg/dL (men) 50-59 mg/dL (women)

1-1.3 mmol/L (men) 1.3-1.5 mmol/L (women)

Better

60 mg/dL and above

1.6 mmol/L and above

Best

Triglycerides (U.S. and some other countries)

Triglycerides* (Canada and most of Europe)

Below 150 mg/dL

Below 1.7 mmol/L

Desirable

150-199 mg/dL

1.7-2.2 mmol/L

Borderline high

200-499 mg/dL

2.3-5.6 mmol/L

High

500 mg/dL and above

Above 5.6 mmol/L and above

Very high

*Canadian and European guidelines differ slightly from U.S. guidelines. These conversions are based on U.S. guidelines.

The American Heart Association (AHA) recommends that a triglyceride level of 100 mg/dL (1.3 mmol/L) or lower is considered optimal. The AHA says this optimal level would improve your heart health. However, the AHA doesn't recommend drug treatment to reach this level. Instead, for those trying to lower their triglycerides to this level, lifestyle changes such as diet, weight loss and physical activity are encouraged. Elevated triglycerides usually respond well to dietary and lifestyle changes.

LDL targets differ

Because LDL cholesterol is a major risk factor for heart disease, it's the main focus of cholesterol-lowering treatment. Your target LDL number can vary, depending on your underlying risk of heart disease.

Most people should aim for an LDL level below 130 mg/dL (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (1.8 mmol/L). In general, the lower your LDL cholesterol level is, the better. There is no evidence that really low LDL cholesterol levels are harmful.

You're considered to be at a high risk of heart disease if you have or have had any of the following:

A previous heart attack or stroke

Artery blockages in your neck (carotid artery disease)

Artery blockages in your arms or legs (peripheral artery disease)

Diabetes

In addition, two or more of the following risk factors also might place you in the very high risk group:

Smoking

High blood pressure

Low HDL cholesterol

Family history of early heart disease

Age older than 45 if you're a man, or older than 55 if you're a woman

Elevated lipoprotein (a), another type of fat (lipid) in your blood

Types of cholesterol

LDL cholesterol can build up on the inside of artery walls, contributing to artery blockages that can lead to heart attacks. Higher LDL cholesterol levels mean higher risk. High-density lipoprotein (HDL) cholesterol is known as "good" cholesterol because it helps prevent arteries from becoming clogged. Higher HDL cholesterol levels generally mean lower risk.

For the most accurate measurements, don't eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.

Lifestyle changes

If your LDL cholesterol is too high, the first thing your doctor will probably suggest is lifestyle changes. These changes include:

Quitting smoking

Eating more soluble fiber, found in oatmeal, beans, fruits and vegetables

Eating less fat and cholesterol from meat and dairy products

Losing weight

Exercising at least 30 minutes a day on most days of the week

Being overweight and inactive tends to increase your LDL cholesterol and lower your HDL cholesterol, exactly the opposite of what you want. Exercise and weight loss can help reverse this trend. This is especially important for people who have large waist measurements — more than 40 inches (101.6 centimeters) for men and more than 35 inches (88.9 centimeters) for women — because people with this body shape are more likely to develop heart disease.

Medications may be needed

When lifestyle changes aren't enough to reach your cholesterol targets, your doctor may prescribe medications to help lower your cholesterol levels. These drugs, such as statins, aren't a replacement for lifestyle changes. You'll still need to eat well and exercise.

A hidden risk factor — family history

High cholesterol has no symptoms, but your genetic makeup — reflected in a family history of high cholesterol — might make you more prone to high cholesterol, even if you eat right and exercise.

That's why it's so important to have a baseline cholesterol test at age 20 and have follow-up tests at least once every five years. Finding the problem early allows you to take action before it's too late. Your doctor may recommend more frequent cholesterol tests if your total cholesterol level or LDL cholesterol level is high, or if you have a family history of heart disease or high cholesterol.

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